CTR072394.M24-0011_Certificate_of_Insurance_OOD_Equipment_Maintenance_and_Repair.pdf

DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE

CONTACTPRODUCER

NAME:

PHONE FAX

(A/C, No, Ext): (A/C, No):

EMAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR

LTR TYPE OF INSURANCE ADDL

INSR

SUBR

WVD POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

AUTHORIZED REPRESENTATIVE

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

09/19/2023

Sentry Customer Service

800-473-6879 800-514-7191 businessproducts_direct@sentry.com

Sentry Select Insurance Company 21180

Sentry Insurance Company 24988

1276670

B 2568383010 10/01/2023 10/01/2024

X

1,000,000

1,000,000

1,000,000

A

X

X

X

2568383006 10/01/2023 10/01/2024

25,000,000

75,000,000

PRODUCTS - COMP/OP AGG 75,000,000

N

Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481

COMMERCIAL GENERAL LIABILITY

A

X

X

X

2568383004 10/01/2023 10/01/2024

1,000,000

500,000

5,000

1,000,000

3,000,000

2,000,000

A

X

2568383005 10/01/2023 10/01/2024

1,000,000

ERRORS & OMISSIONS

Employee Benefits Errors & Omissions

Occurrence Limit Annual Aggregate Limit Deductible

All Other Errors & Omissions

Occurrence Limit Annual Aggregate Limit Deductible

A 2568383008 10/01/2023 10/01/2024

500,000 1,000,000 1,000

250,000 500,000 10,000

Arizona Department of Emergency and Military Affairs 5636 Easat Mcdowell Rd Bldg M5330 Phoenix, AZ 85008

09/19/20232568383

Sentry Select Insurance Company 00001 0000000000 23262 0 N1 d3af9a3f-1b78-44e8-b1a8-47794690ab4ed3af9a3f-1b78-44e8-b1a8-47794690ab4e

DATE (MM/DD/YYYY)

CERTIFICATE OF LIABILITY INSURANCE

CONTACTPRODUCER

NAME:

PHONE FAX

(A/C, No, Ext): (A/C, No):

EMAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSR

LTR TYPE OF INSURANCE ADDL

INSR

SUBR

WVD POLICY NUMBER POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

AUTHORIZED REPRESENTATIVE

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

OTHER:

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

SCHEDULED

AUTOS

HIRED

AUTOS ONLY

NON-OWNED

AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB

OCCUR

CLAIMS-MADE

DED RETENTION $

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below

Y / N N / A

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

EACH OCCURRENCE

AGGREGATE

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

Arnold Machinery Company PO Box 30020 Salt Lake City, UT 84130-0020

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

09/19/2023

Sentry Customer Service

800-473-6879 800-514-7191 businessproducts_direct@sentry.com

Sentry Select Insurance Company 21180

1276670

Sentry Insurance 1800 North Point Drive Stevens Point, WI 54481

$AGGREGATE LIMIT

$POLLUTION INCIDENT LIMIT

CLEANUP COSTS-COVERED

LOCATION LIMIT

CLAIMS-MADE OCCUR

POLLUTION LIABILITY

N / AXA 2568383009 10/01/2023 10/01/2024

1,000,000

1,000,000

100,000

Arizona Department of Emergency and Military Affairs 5636 Easat Mcdowell Rd Bldg M5330 Phoenix, AZ 85008

09/19/20232568383

00001 0000000000 23262 0 N1 21a49779-f353-478c-9000-fa894f09754a21a49779-f353-478c-9000-fa894f09754a

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

ADDITIONAL REMARKS

NAMED INSURED

EFFECTIVE DATE:

Arnold Machinery Company

XXXXXX2120

2 2

Bruce Johansen

2568383009

Sentry Select Insurance Company 21180 10/01/2023

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:ACORD 25 Certificate of Liability Insurance

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD 09/19/20232568383

AGENCY CUSTOMER ID:

LOC #:

ADDITIONAL REMARKS SCHEDULE Page of

AGENCY

POLICY NUMBER

CARRIER NAIC CODE

ADDITIONAL REMARKS

NAMED INSURED

EFFECTIVE DATE:

Arnold Machinery Company

XXXXXX2120

2 2

Bruce Johansen

2568383004

Sentry Select Insurance Company 21180 10/01/2023

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

FORM NUMBER: FORM TITLE:ACORD 25 Certificate of Liability Insurance

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD 09/19/20232568383